title: Meningitis due to penicillin-resistant Streptococcus pneumoniae in adults.
abstract: A 33-year-old woman with quiescent systemic lupus erythematosus developed meningitis due to a penicillin-resistant strain of Streptococcus pneumoniae. After an initial failure of penicillin therapy, the patient responded to cefotaxime. The meningitis was complicated by total neurosensory hearing loss. Howell-Jolly bodies noted on peripheral blood smear led to a radionuclide spleen scan, which documented functional asplenia. This woman is the second patient in the United States with meningitis caused by a strain of S. pneumoniae moderately resistant to penicillin G (minimal inhibitory concentration, 1.0 microgram/mL). The resistant isolate displayed resistance to penicillin that was not of enzymatic origin but rather was due to an alteration of penicillin-binding proteins. This experience illustrates the importance of testing the in vitro susceptibility of the pneumococcus to penicillin G.
authors.affiliation: Department of Medicine, Providence Medical Center, Portland, Oregon 97213.
authors.forename: R D
authors.initials: RD
authors.lastname: Weingarten
authors.forename: Z
authors.initials: Z
authors.lastname: Markiewicz
authors.forename: D N
authors.initials: DN
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D001426:Bacterial Proteins; D002352:Carrier Proteins / Q000032:analysis; D002701:Chloramphenicol / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000517:prevention & control; D006602:Hexosyltransferases; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D002267:Muramoylpentapeptide Carboxypeptidase / Q000032:analysis; D010400:Penicillin G / Q000494:pharmacology / Q000627:therapeutic use*; D010403:Penicillin Resistance; D046915:Penicillin-Binding Proteins; D010458:Peptidyl Transferases; D013296:Streptococcus pneumoniae / Q000032:analysis / Q000187:drug effects*
chemical_list: D001426:Bacterial Proteins; D002352:Carrier Proteins; D046915:Penicillin-Binding Proteins; D002701:Chloramphenicol; D003907:Dexamethasone; D010458:Peptidyl Transferases; D006602:Hexosyltransferases; D002267:Muramoylpentapeptide Carboxypeptidase; D010400:Penicillin G